Got a Healthcare IT Renovation Project? We have a DIY Book for you!

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host Brian Urban and today we're going to continue to speak with amazing authors and executives across the industry. And we have a guest here today who not only is an executive but is a rising author in the space of healthcare IT. In fact, her latest book is Renovating Healthcare IT, Building the Foundation for Digital Transformation. So joining us from Al Rio community health, the chief information officer and author of this wonderful book is Susan Snedaker. Susan, thank you for joining our little show today.

Susan Snedaker:

Thanks Brian. It's great to be here.

Brian Urban:

This is going to be a ton of fun. We've gotten to know each other here and there. Didn't get to see you at HIMSS this year, you weren't able to make the trip. But alas, we have the power of virtual podcasting here to bring us together. So Susan, before we dive into the book, want to have our audience get familiar with yourself. So take us back before you became an executive of a federally qualified health center, a very large community health center at that, and before you became an author, before all of this recognition that you're receiving these days. Who is Susan and how did you find yourself getting into healthcare IT?

Susan Snedaker:

Well, it's sort of a circuitous story and I say often that people tend to either know what they're going to be when they pop out of the womb or they don't. And I was one of those people who didn't and I just sort of wound my way through a different path and found myself here. So I got into computers early on and I spent a lot of time in basic computer hardware, software, maintenance, repair as a field technician then a regional specialists and so forth. So got to know computers really well. Got my MBA. So then I learned a lot about business and I started putting those things together and eventually started doing some consulting and worked for a wide variety of organizations. And a couple of them were in healthcare IT and this was early on. So it got me interested in the space. I worked for Microsoft for a while and then worked for a large outsourcing company. So was sort of inside, outside with Microsoft and learned a tremendous amount from that experience. So when I found the opportunity to get into healthcare IT, I was actually consulting and was brought into a large community healthcare system to help tune up one of the departments in IT and that turned into a full-time gig and I was there for 12 years.

Brian Urban:

Oh, there you go.

Susan Snedaker:

The operation security officer eventually. So I really learned about healthcare IT in that role and it was a tremendous experience. And then about three years ago the opportunity to join El Rio as the CIO opened up and I jumped at the opportunity because it's such a great organization.

Brian Urban:

I love it Susan. And great organization, great mission, the lives you serve are of high need and of high sophistication in terms of healthcare IT. And I love where your book takes the readers. I found it in two parts. One quite literally, maybe you didn't intend this, but a textbook of an academic nature. And then the other end of it, I think, is really a how-to guide helping determine where a healthcare IT life lives right now for an organization and the tools you have and where you want to go and how do you start to cross that chasm. So I found it very helpful beginning to end for someone who isn't intimately involved in the technical side of healthcare IT with my own organization, so very helpful. And to kick us off with learning more about your book here, Renovating Healthcare IT, why the book now? Is it because of the financial squeeze and cybersecurity threats that a lot of healthcare IT individuals and leaders face today? Or are there other reasons of why you had taken the book to market within the last year or so here?

Susan Snedaker:

Yeah. So I think we all experienced the pandemic in healthcare IT as one that sort of unleashed potential. So it was a horrible experience in the world, but the bright side of it was that it showed us that we could rapidly implement innovative solutions when everybody was on board. And so it sort of cracked open that wall that had always been hard to get through in healthcare IT, which was let's try something new. So that sort of broke it open and then it was sort of the wild west. So then we had everybody wanting all these new innovative things and as I was working through the El Rio systems, I had just arrived and there were many IT systems that were obsolete that hadn't been maintained or updated. There were patched together things, which is true of so many healthcare systems. So that's not a criticism of those who came before me, it's a statement of the reality of healthcare IT.

And so I began looking at how do we fix this while we're still operating, while we need to still innovate. And as I often say, I tend to write the book I want to read because I was looking around for resources to help guide me through this massive renovation. I knew how to do it, but I thought, well what are the best practices and what are others doing and how can I leverage that? And I didn't really find anything and I thought, "Well I guess I'll just have to write that book". And that's where this came from. It's interesting that you call it sort of part textbook and part how-to guide and I think you really nailed it. I don't know if that was my initial intent, but when I write my books I really want to provide the reader with background and context that they might not otherwise have.

And I find when I talk with other healthcare IT leaders, especially those who maybe haven't been in the role as long, they have gaps in their knowledge about what the healthcare environment is and what it looks like and how to operate as a business inside of that, which is what healthcare IT is. And so I tend to like to educate as well. And then I was just thinking about this this morning. I was reading something and the author said, "Well, these are some of the problems and these are some of the solutions". And then it stopped and I thought, "Oh, if you had just brought it to the next step and said for example, this is how three other people have solved this problem", it helps the reader generate ideas and apply the material. And so that's what I always try to do.

Brian Urban:

That, I think, is extremely helpful. The four examples bring it into reality for a reader that can put it into application for their own world, extremely helpful. And that I think is that textbook how-to guide combination, that's extremely helpful for a brain like mine that is working on different projects of the renovation nature that is related around healthcare IT. So I think it's just so helpful in the approach that you have. And it's interesting because you open up the book talking deeply about EHR and how there have been an enabler across healthcare IT. And then you go all the way into population health, mental health disparities, you go into the value chain of healthcare IT, you really touch the whole spectrum, which is really cool. And I wanted to get in particular, I'll fast forward a little bit through the book and then maybe kind of work my way backwards here with my questions, the value chain of healthcare IT. You talked about the comparison of maybe old and new, of measuring impact on stakeholders versus measuring impact on the efforts that are made through healthcare IT. And I think you think about the labor and the resources aligned to it. Take us a little bit deeper into what you mean by the value chain associated with healthcare IT and maybe where a lot of organizational leaders need to think of how that value chain is making an impact on stakeholders.

Susan Snedaker:

Yeah, that's a really good question. I think really timely right now given everybody's got a squeeze on their budget. And the way I look at it is often in IT we say this project costs this much money, we expended this much labor, we achieved these things. And that's good for internal IT, but from an organizational standpoint, they don't really care. What they care about is what did you do for me? And they should, we're a service organization, that's our job to deliver value to the organization. So being able to articulate what we do in terms of the value to the organization is far more important because they need to understand, yes, maybe it takes a lot of time or money or resources, but more importantly these are the outcomes we've delivered for you. And some of them are easier to see than others. So for example, setting up quality dashboards and generating data that helps the organization improve quality, that's very tangible.

It's easy to look at and say there's the value. On the flip side, and I was just having this conversation the other day, how do you articulate the value of your cyber security efforts when the bad thing has not yet happened? And I say not yet because it's almost inevitable for all of us, but it's hard to prove value in the absence of anything. So the value is we haven't had an attack, we haven't had a breach, we haven't had a whatever. That's much harder to articulate to the organization. So I think IT leaders need to become versed in both those conversations. And the first one about the value of the dashboards or the value of the new features in the EHR are easier to articulate.

And I call that to my team, I say "That's our marketing". You have to make sure that the team that you are working with, your end users and stakeholders, understand what you're providing to them. Don't talk about how hard it was for you, talk about what you've delivered for them. That's marketing IT. The cyber security example is more, I think, an executive level conversation around risk management because that's where folks understand at the executive level and the board level when you talk about this is what we're doing for our cyber security efforts. And yes, it takes time, money, and resources, but we're as protected as we can be. That's a different conversation at a different level.

Brian Urban:

And it's important to have, I think, the reader understand what's important to share, when and who to be able to not only showcase the value and the efforts that you're executing as a part of the value chain you're describing here in healthcare IT, but really where we also need to continue to innovate and develop more features around security, etc. So I think those very anecdotal level insights that you're giving the reader, super helpful. And I think the depth that you go into, especially with EHR is really, really neat. So I want to take a transition into that, Susan. So I've looked at a couple of different trends, reports. FinThrive ourselves, we've done a research report recently with HFMA. And what we're starting to see across the industry is obviously Epic is a huge volume leader and then behind them, Cerner and MEDITECH and then a bunch of other smaller EHRs.

And it seems like the back end part of the revenue cycle and analytics is really the next opportunity for continued explosion growth in the EHR vendor space. So I want to get your take here a little bit off of your book and maybe into your CIO world. We'll put that hat on for a second. What you see maybe really transforming the growth and investment into analytics that are a part of EHRs today? Like what the future will be with some of those vendors that are still trying to develop a lot of other features and work well with other third party vendors too?

Susan Snedaker:

It's a real large and growing area, as you indicated. And I think the revenue cycle area is extremely challenging for everyone, for all the players in the field, because it's complicated on many, many levels. I think some of the leading EHR vendors and certainly Epic is working... Because we're on Epic and we're working toward automating some of the revenue cycle functions inside of Epic. Those are features inside of Epic. And I think automation is sort of the building block of using machine learning or AI. So they're not the same thing at all, but the one leads to the next, right? So automation can help streamline speed up, reduce errors. And in revenue cycle especially the billing claims, management function, that can be really very, very helpful. And we're looking at automation and AI with payers to do prior off and things like that more streamlined.

So it will reduce our effort, but it will also reduce payer effort. And I think that can hopefully help reduce costs, but improve care through faster turnaround. So ultimately it's about improving care. From the analytics standpoint, there's just this mushrooming of data which we all have been dealing with. And I think what I see as the challenge right now, and it's been there for a while this is nothing new, there's massive demand in organizations for reports and analytics and data. And it's all well-meaning, but I would argue that about 80% of what's requested is either used once or used never, and then it just becomes this cluttered inventory. So part of the renovation is really cleaning the closets and the junk drawers of your analytics area and getting really... And it's tough. I mean, I think this is one of the most difficult areas right now, which is developing organizational processes around data management and data governance.

And people may have governance models that help them prioritize what they're going to send their analytics team off to do. But the corollary to that, and it's one that we're digging deeply into right now, is how do you get the organization to either utilize the data or get rid of the data? So that's the management aspect because that clutter becomes problematic. You have data that gets outdated or it doesn't get refreshed or never gets used, and the cost of that is enormous when you have a BI team just spinning their wheels, pumping out reports that nobody ends up using. So to me, I always go to what's the solution? How do you fix that problem? And I think a lot of it has to do with helping the organization understand the burden that that creates on the whole organization, have this waste, and then how to better leverage it.

And a lot of times that involves education and training of end users and operational folks around how to use reports and basic analytics. So they figure out how to make this data actionable. Because the BI team can produce just about anything, but then what action are you going to take? And so developing processes around, okay, we've developed this report, or if we're going to develop this report, what actions are you going to take and what outcomes are you looking for? And will this report help drive that? And what success criteria are you going to use now that you have this data? And so having shared accountability, which I think is often missing.

Brian Urban:

I love that you went to that level, Susan, because it's one thing to develop a very thoughtful, insightful dashboard and a report, but it's another thing to say, "Okay, what's in this dashboard that I can take into action?" So it's a two part play there that I think you start to walk through in the change management portion of your book here. And I like that you called out in particular four methods of change management, the two front ones that you mentioned in your book as you're going in this chronological order here, you have Cotter's model of driving urgency, you have Lewins, which is the freezing and unfreezing stages, maybe a little bit more tack in that model, but trying to get adoption of new ideas and drive them into execution is a challenge. And of those methods, I'm curious, in your experience, Microsoft and now at CIO at a community health center, El Rio, what methods have you deployed in those four examples that I'm curious of our audience might take away and use for their own good?

Susan Snedaker:

I think I've probably used parts of all of them over time because they all have good uses and they all have some limitations. I think more generally because I think an organization needs to adopt a change management method that really reflects the way the organization operates. So picking the model is important, but they all have similar elements. And to me, one of the key things that stands out for me about change that I don't think is often enough discussed is that change means that whatever the person has been doing and developed expertise in is going away. So the threat to every human that deals with change is loss of expertise. And in healthcare and healthcare IT that's huge. Our providers, our nurses, our MAs, our business office, our IT folks, our facilities folks, they gain expertise by using the systems they're using. And then we say, "Hey, that's going away. Here's a new one".

And to acknowledge that they lose their expertise, and that's very threatening and scary to everybody, is to me the most fundamental way to make change. More successful, acknowledging that and then showing the path forward, road mapping it out and saying, "Okay, these are the five steps or the 10 steps we're going to take to ensure that you become competent in the new system, the new process, the new way of doing things". And when you do that and you provide that roadmap along with the why, why are we doing this, why does this matter, why is it important for you to gain this expertise, that's how change sticks and that's how change can be successfully deployed. And I think every time I've seen change fail, it's because that element of acknowledging loss of expertise has not been addressed.

Brian Urban:

Wow. I can assimilate immensely with that example because when we, speaking of large organizations for myself, Highmark signal Walgreens, we have these huge workflows to navigate. Huge departments of people, but when we forget about the loss of expertise and those that have a unique fit into executing a project or a brand strategy or standing up different analytic reports, then we really have a weak link in the chain of providing value to whatever project we're trying to work on. So the loss of expertise from a clinical standpoint tenfold because they're facing the lives that are there for clinical help, social health work, and that's the most priceless thing that you need to protect, especially when you're thinking about change management and renovation. I love that you went there. That is not something that I would've expected to hear, but perfect example. So Susan, I want to get a final word and kind of a look into the future for you. So for those right now that are going through a healthcare IT renovation relative to revenue cycle, analytics, any clinical workflows, anything, what would be your two or three big takeaways for them to think about as they're going through their renovation project? Relative to your own experience or even what you've put out in the book here.

Susan Snedaker:

The first thing is to always focus on fundamentals. When I think about healthcare IT systems, it's easy for us to chase the shiny new object. It's certainly easy for our users to do so, and we in IT tend to love new stuff. So we can become wrapped up in those things. But focusing on fundamentals that are really boring but really important, like making sure your servers are hardened and your systems are patched and encrypted and your cybersecurity systems are in place, and you have two-factor authentication for remote access, just the fundamentals of managing systems. Managing change management on the EHR, having processes around how do we request changes, all of those real fundamental things keep the building clean, if you will. So I think about everyone's talking about AI these days, of course, and I was thinking about it this morning and I thought the analogy is sort of like having one of those robotic floor cleaners or vacuums, when you've got clutter all over the place and on the floors, it can't work very well. So we have to renovate our space, we have to clean it up and get rid of the old stuff, organize it so that we can successfully deploy things like automation, things like machine learning and AI, because AI will just make a big mess bigger.

And so it's not magic and it's not going to fix those fundamental things for us. I think it's got tremendous promise, but there's a lot of noise around it right now. Because everybody wants it, but nobody's sure exactly what it is or what it should be in healthcare.

Brian Urban:

[inaudible 00:23:53]

Susan Snedaker:

Yeah. I mean, it's sort of the new frontier and it's exciting and it's fun and it's innovative, but we have to do this on a foundation of solid systems. And so cleaning those things up, organizing those things, from your service desk to your systems, to your EHR applications, to your enterprise applications and everything in between, it's gratifying work because it's pretty tangible. And that's what I often say to my teams is, "I know it's not the new cool thing, but it's also something you can look at and say, look, last week or last month or last quarter, we achieved X, Y, and Z". And so you sort of get to pile up your achievements and that feels good. And meanwhile, you're cleaning up your shop. And I think the reason I wrote the book in such a modular way was really so that you could pick and choose. Everybody's got a different organization and a different set of stressors. So pick the thing that's easiest or pick your biggest problem, you can select it and create your own program using the method in the book because I made it so that you can plug in whichever way you want to go. But the point is start now and get going because it's not going to get any easier.

Brian Urban:

I love that. Make sure the house is built on a strong foundation, cleaning up things, and getting the fundamentals right, and then you can chase all of the very exciting things like generative AI and what that could be doing for advancing some of your workflows, your analytics, et cetera. And Susan, I want to take a look into the future now here having said that, what do you think your book here, Renovating Healthcare IT, will contribute to the ecosystem and readers like myself and others over the next five years? Do you think it's going to provide a good stepping stone, or do you think there's going to be some serious transformation that you might add into your next book here? Give us some predictions for the future based off of what you've seen your book already have an impact with.

Susan Snedaker:

Well, that's an interesting question. I don't have a crystal ball unfortunately, but when I do look forward, obviously AI, machine learning, generative AI is really going to continue to have a huge, huge impact on healthcare and healthcare IT. I see it as really being able to shift the way we do some of our work. And so for example, if I've got server folks who are writing scripts to do things, well AI can probably do that now. So to me, it's looking at the way humans are uniquely qualified to do what we do and how machines are uniquely qualified to do what machines do and better carving out those roles and responsibilities going forward. So in the future, there's got to be machine role and human role, and I think that that's a very exciting place to be. But again, it starts with having a clean house.

And so I'm hoping that in this book that people can understand the current ecosystem, can have a systematic approach to renovating, updating, getting all their systems started, dusted off, cleaned up and ready to go, and then really looking at how AI can shift the model so that we can provide better care. Because ultimately that's really the thing that matters the most, is how do we improve the quality of care that we provide to our patients? And we're in an FQHC, so we provide primary care, and that is one of the biggest shortages we have in the US. It's a huge, huge problem, and it creates an enormous healthcare burden on humans in terms of poor quality health, worse outcomes, all of those things. So all of these things we do in healthcare IT might be interesting to us as IT people, but ultimately we need to find a way to provide better care to more people at a better cost.

Brian Urban:

Wow. So well said. I don't think we could go any further than where we've come to be right here, Susan, but all the healthcare IT leaders out there and even those that are more of the doers today, highly suggest Susan Snedaker's latest book here, Renovating Healthcare IT, Building the Foundation for the Digital Transformation. And there's so much to think about, but how your work today will contribute toward better care for the lives that are ultimately served is the foundation of this book, the building block of it. I am a fan. Thank you so much, Susan, the Chief Information Officer at El Rio Community Health and obviously a known author. Thank you for joining our show here today.

Susan Snedaker:

Thank you so much, Brian. I've had a great time and I really appreciate the opportunity.

Brian Urban:

Absolutely. So, so much fun. And for more exciting insights and excerpts, please visit us at finthrive.com.